Provider Demographics
NPI:1811942725
Name:HAMBURG, MITCHELL S (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:S
Last Name:HAMBURG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 WASHINGTON ST STE 6100
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5901
Mailing Address - Country:US
Mailing Address - Phone:816-932-3470
Mailing Address - Fax:816-932-3492
Practice Address - Street 1:4321 WASHINGTON ST
Practice Address - Street 2:SUITE 6100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5961
Practice Address - Country:US
Practice Address - Phone:816-932-3470
Practice Address - Fax:816-932-1383
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7D76207RE0101X
KS0427853207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100145580AMedicaid
MO202488615Medicaid
C51559Medicare UPIN
MO202488615Medicaid